introduction to disaster management€¦ · introduction to disaster management this module has...

Introduction to Disaster Management

Introduction to Disaster Management

This module has been developed to give you a better understandingof emergency management concepts and is divided into four units.

• UNIT 1: Introduction to Emergency Management Principles

• UNIT 2: WA Emergency Management Arrangements

• UNIT 3: Pre-Hospital Emergency Management

• UNIT 4: WA Health System and Hospital Emergency Management

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UNIT 1: Introduction to Emergency Management Principles

UNIT 1 - Introduction to Emergency Management Princi ples

WHAT IS AN EMERGENCY?

Emergency Management Australia defines an emergency as:

"An event, actual or imminent, that endangers or th reatens to

endanger life, property or the environment, and whi ch

requires a significant and coordinated response".

More simply, an emergency is a situation that is beyond the capacity of normalorganisational arrangements to manage.

In emergency management in Australia, the terms 'emergency' and 'disaster' are oftenused interchangeably.

An emergency or disaster occurs when a hazard (a hazard is a situation or condition withthe potential to harm people or the environment) impacts upon a vulnerable community.

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HAZARDS IN WESTERNAUSTRALIAWestern Australia (WA) coversnearly one third of the Australiancontinent.

The size, remoteness and diversityof the setting presents a variety ofnatural and technological hazards.

Natural hazards include those ofclimatic, geophysical or biologicalorigin.

Technological hazards include thosearising from nuclear, chemical andbiological origins, human fault andhostile action.

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HAZARDS IN WESTERN AUSTRALIA

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EMERGENCY MANAGEMENT PRINCIPLES

Emergency management is a range of measures taken to manage risks tothe community and the environment.

Australian emergency management concepts are based on the followingprinciples:

• Risk management approach

• Shared responsibility for resilience

• All hazards approach

• Graduated approach

• All agencies coordinated and integrated approach

• Continuous improvement

• Community engagement

• Integrated information management

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COMMAND, CONTROL & COORDINATION

Command

Command relates to the direction of members and resources within a singleorganisation and operates vertically within an organisation. The person withoverall responsibility for the activities and resources of a single organisation is thecommander of that organisation

Control

Control relates to the overall direction of emergency management activities in anemergency situation and operates horizontally across organisations. It carries withit the responsibility for tasking and coordinating other organisations Control of anemergency is vested in the Hazard Management Agency (HMA) for that particulartype of emergency.

Coordination

Coordination relates to the acquisition and use of resources in accordance withthe needs of the emergency and operates as a function of command and control.

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Command• The vertical line of authority

within each agency & support service

• Each service has ONE individual who is in command

Control• The horizontal line of authority

across the emergency & support services

• The incident has ONE individual who is in overall control (the incident controller)

Coordination• Primarily concerned with the

systematic acquisition and application of resources

REFERENCES

• Emergency Management Australia 1998, Australian Emergency Management Glossary, Emergency Management Australia, ACT

• Emergency Management Australia 1999, Disaster Medicine; Second Edition, Emergency Management Australia, NSW

• OEM WEBSITE https://www.oem.wa.gov.au/emergency-management/state-em-framework/em-principlesWA

• Risk Management https://www.oem.wa.gov.au/emergency-management/portal/risk

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UNIT 2: WA Emergency Management Arrangements

GOVERNMENT RESPONSIBILITIESEach level of government has its own clear roles in emergency management.

Federal GovernmentThe role of the Federal Government is to:

• Support the states in developing their emergency management capabilitiesacross prevention, preparedness, response and recovery

• Provide assistance to the states during a disaster if required

• Provide financial relief following a disaster if required

• Provide assistance when emergencies occur overseas

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UNIT 2 – WA Emergency Management Arrangements

State and Territory Governments

• Under the Australian constitution, State and Territory Governments haveprime responsibility for the safety of life and property.

• Each State and Territory has its own emergency management legislation.

• In WA, the emergency management arrangements are governed by theEmergency Management Act 2005 (the Act). The Act provides theframework for the prompt and coordinated management of emergenciesrequiring a significant and coordinated response.

• The Act is supported by regulations (Emergency ManagementRegulations 2006), by the State Emergency Management Policy, StateEmergency Management Plan, State Health Emergency Response Plans(SHERP) and State Hazard Plans.

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State Emergency Management Framework

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Local Governments

Local Governments are required to ensure that effective emergencymanagement arrangements are prepared and maintained for thearea and to manage recovery following an emergency affecting thecommunity.

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THE HAZARD MANAGEMENT STRUCTURE

The hazard management structure describes the relationship betweenEmergency Management Agencies (EMAs) i.e. HMAs, CombatAgencies and Support Organisations. EMAs are established throughlegislation and are involved with preventing, preparing for, responding toand/or recovering from emergencies.

Hazard Management Agencies

A HMA is a public authority or other person, prescribed byregulations because of that agency’s functions under law or becauseof its specialised knowledge, expertise and resources. The HMA isresponsible for prevention of, preparedness for, response to andrecovery from emergencies caused by that particular hazard.

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Combat AgenciesThe role of a combat agency is to minimise the impact of an emergency bymitigating the ongoing hazards. This can be through performing tasks oractivities, such as:

Support OrganisationsA support organisation is an organisation whose role in an emergency is eitherto restore essential services (such as water, electricity, etc.) or to providesupport functions such as welfare, medical and health, transport,communications, etc.

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• Firefighting• Rescue• Temporary building restoration

• Evacuation• Containment of oil spills• Monitoring of radioactive materials, etc.

STATE HAZARD PLANS

• A full list of the State Hazard Plans in place in WA is available through theOffice of Emergency Management website, under State EM Framework.

• An organisation designated as the HMA for any particular hazard isresponsible for writing the State Hazard Plan for that hazard.

• Combat agencies are responsible for assisting the HMA in the developmentof state level hazard plans.

• Support organisations are responsible for developing their own plans.

• These plans are different to hazard plans in that they are written to be applied to a range of hazards, but cover only certain aspects of the emergency.

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Level 1• There are no significant issues

• There is a single or limited multi-agency response (day-to-day business)

• The incident area is limited in extent (i.e. to one jurisdiction or district)

• The response duration is within a single shift

• Resources can be sourced from one local government district

• There is minimal impact on the community and critical infrastructure

• The incident can be managed by a Controlling Agency IMT only

• There is a low level of complexity and / or

• There is potential for incident escalation

Level 2• A limited multi-agency response is

required

• Coordination of multi-agency resources is required

• There is a duration covering multiple shifts

• There is medium term impact on critical infrastructure

• Resources are sourced from district or State level

• There is a medium level of complexity

• One or two incident areas are involved

• There is a medium impact on the community(health, safety, economic, technological or other)

• There is potential for the incident to be declared an ‘emergency situation’ and / or the incident involves multiple hazards

Level 3• Requires significant coordination of a

multi-agency response

• There is a protracted response duration

• There is significant impact on criticalinfrastructure

• Resources need to be sourced fromState, National and even International level

• There is a high level of complexity

• There is significant impact on the routine functioning of the community (health, safety, economic, technological or other)

• There are multiple incident areas

• Evacuation and / or relocation of community is required

• There is actual or potential loss of life or multiple, serious injuries and / or

• A declaration of an ‘emergency situation’ or ‘state of emergency’ is likely

INCIDENT LEVELS

Incidents are broadly classified into three levels. It is recognised that there will be some overlap between levels and theIncident Controller (IC) will determine the incident level based on the actual and / or potential impact of the incident. Theoperational level is broadly defined as including more than one of the following:

THE OPERATIONS STRUCTUREOperational groups are established only when an emergency occurs (or inanticipation of an emergency that is about to occur). They are involved primarilyin the response phase and are made up of representatives from all agenciesthat need to be involved in the response.

ISG � OASG � SECG

Incident Support Group (ISG)

The ISG consists of representatives (liaison officers) from organisationsinvolved in the incident and relevant service providers, such as ambulance andrepresentatives for essential services (e.g. phone, water and electricity). Thefunction of the ISG is to assist the IC through the provision of information,expert advice, support and resources relevant to their organisation.

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Operational Area Support Group (OASG )

The HMA may activate an OASG to provide strategic support to theemergency response, when multiple agencies need to becoordinated at a district level or multiple incidents are occurringsimultaneously within one operational area.

State Emergency Coordination Group (SECG)

The SECG coordinates activities throughout the State whenrequired and liaises with the Emergency Services Minister. Theoperational management structure integrates the HazardManagement Structure and the Multi Agency Support Structure tomanage a level 2 or level 3 multi-agency incident.

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THE RECOVERY STRUCTURELocal governments are responsible for managing recovery activities in their area.

The State level has a role in recovery as it may need to ensure that localgovernments have equitable and appropriate access to resources for recovery.

The Australian government has a number of recovery programs which providefinancial assistance for disaster recovery:• The Natural Disaster Relief and Recovery Arrangements (NDRRA)

– A jointly funded program between the Commonwealth and the states andterritories

• The Disaster Recovery Payment (DRP)• The Disaster Recovery Allowance (DRA)

DRP and DRA are Commonwealth only funded programs , activated by the Ministerfor Justice, through which financial assistance can be provided directly to disasteraffected individuals. https://www.oem.wa.gov.au/funding

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WA EMERGENCY MANAGEMENT ORGANISATIONSThe tables displayed over the following slides provide information on prescribed hazards and their associated HMA, organisation and controlling agency.

Hazard Hazard Management Agency

Organisation

Air Crash Commissioner of Police WA Police

Animal or Plant; pests or diseases Agriculture Director General Department of Agriculture and Food WA

Injury or threat to life of persons trapped by the collapse of a structure of landform (collapse )

Fire and Emergency Services Commissioner

Department of Fire and Emergency Services

Cyclone Fire and Emergency Services Commissioner


Earthquake Fire and Emergency Services Commissioner


Loss of interruption to the supply of electricity that is capable of causing or resulting in loss of life, prejudice to the safety, or harm to the health, of a person (electricity supply disruption )

Coordinator of Energy Public Utilities Office, Department of Finance

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WA EMERGENCY MANAGEMENT ORGANISATIONS


Organisation

Fire Fire and Emergency Services Commissioner


Flood Fire and Emergency Services Commissioner


Loss or interruption to the supply of natural gas, that is capable of causing or resulting in the loss of life, prejudice to the safety, or harm to the health, of a person (gas supply disruption )

Coordinator of Energy Public Utilities Office

Actual of impending spillage, release or escape of a biological substancethat is capable of causing loss of life, injury to a person or damage to the health of a person, property or the environment

State Health Coordinator WA Health

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Organisation

Actual or impending spillage, release or escape of a (a) chemical, (b) radiological or (c) other substance (HAZMAT)that is capable of causing loss of life, injury to a person or damage to the health of a person, property or the environment

Fire and Emergency Services Commissioner


Heatwave State Health Coordinator WA Health

Human Epidemic State Health Coordinator WA Health

Land Search – for persons lost or in distress, that requires a significant coordination of search operations

Commissioner of Police WA Police

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Organisation

Loss of or interruption to the supply of liquid fuel as defined in the Liquid Fuel Emergency Act 1984 (Cwlth) section 3(1), that is capable of causing or resulting in loss of life, prejudice to the safety, or harm to the health, of a person (liquid fuel supply disruption)

Coordinator of Energy Public Utilities Office

Actual or impending spillage, release or escape of oil or an oily mixture that is capable of causing loss of life, injury to a person or damage to the health of a person, property or the environment (marine oil pollution)

Marine Safety, General Manager Department of Transport (DoT), Marine Safety • State waters;

• shipping and pilotage waters; and• port waters (Level 2/3).

Port Authority• port waters (Level 1).

Petroleum titleholder• State waters (Level 1).

Marine Search— for persons lost or in distress on inland waterways within the limits of a port or in a fishing vessel or pleasure craft within the limits of a port or at sea


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Organisation

Actual or impending event involving a ship that is capable of causing loss of life, injury to a person or damage to the health of a person, property or the environment (marine transport emergency)

Marine Safety, General Manager DoT Marine Safety• State waters;• shipping and pilotage waters; and• port waters (Level 2/3).

Port Authority• port waters (Level 1).

Radiation Escape from a Nuclear Powered Warship


Rail Crash PTA Network (passenger) - Public Transport Authority (PTA)

• PTA; or

• WA Police or DFES, by agreement, following the declaration of an emergency situation or state of emergency or circumstance where the demands of the situation are deemed to exceed the capacity or capability of the PTA.

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Organisation

Rail Crash Brookfield Rail Network (freight)- Brookfield Rail Pty Ltd (Arc Infrastructure)

• Brookfield Rail (Arc Infrastructure) ;

or• WA Police or DFES, by agreement, following the declaration of an emergency situation or state of emergency or circumstance where the demands of the situation are deemed to exceed the capacity or capability of Brookfield Rail.

Road Crash Commissioner of Police WA Police

Space Re-entry Debris Commissioner of Police WA Police

Storm Fire and Emergency Services Commissioner


Terrorist Act Commissioner of Police WA Police

Tsunami Fire and Emergency Services Commissioner


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REFERENCES• Government of Western Australia, Emergency Management Act 2005

• St John Ambulance Service (Western Australia) 2008, Ambulance Emergency Management Plan 2014, St John Ambulance (Western Australia), Western Australia

• WA Police - https://www.police.wa.gov.au

• Dept of Fire & Emergency Services - https://www.dfes.wa.gov.au

• Office of Emergency Management - https://www.oem.wa.gov.au

• Disaster Preparedness and Management Unit 2016, State Health Emergency Response Plan Interim (SHERP), Western Australia Department of Health, Western Australia

• Disaster Preparedness and Management Unit 2016, Infectious Diseases Emergency Management Plan (IDEMP), Western Australian Department of Health, Western Australia

UNIT 3: Pre-Hospital Emergency Management

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UNIT 3 – Pre-Hospital Emergency Management

ST JOHN AMBULANCESt John Ambulance WA Ltd (SJA) is the contracted provider of ambulance services inWA and is a prescribed combat agency under the emergency management regulationsfor health care provision in the pre-hospital environment.

During an emergency, the role of SJA will depend on the situation; however, theirresponsibility will be generally related to pre-hospital management of casualties and mayinclude:

• Provision and coordination of a pre-hospital response to emergencies

• Provision of appropriate triage and treatment at the emergency site

• Provision of logistical support to the WA Health response to emergencies

• Management and transport of casualties in consultation with WA Health

• Provision of transport of initial hospital response team(s)

• Provision of trained specialist CBRN and urban search and rescue (USAR) paramedics as requested by the nominated HMA

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UNIT 3 – Pre-Hospital Emergency ManagementSJA emergency response arrangements are detailed in the Ambulance EmergencyManagement Plan (AmbPlan – WA). Under the AmbPlan – WA, the ambulance service directoris responsible for the coordination of ambulance services during an emergency.

Metro Ambulance Service

• SJA supports the ever-growing Perth metropolitan area with 35 ambulance depots staffed by more than 720 paramedics and patient transport officers.

• The metropolitan area is serviced by 31 depots staffed day and night by rotating crews, as well as four which are day ambulance locations.

Country Ambulance Service

• There are 162 SJA locations operating in country WA, serviced by more than 3100dedicated volunteer ambulance officers and 90 paramedics.

• In larger country areas where population and ambulance call outs are high, careerparamedics work alongside volunteer ambulance officers to provide the ambulanceservice. These locations are Albany, Australind, Broome, Bunbury, Busselton, Collie,Dawesville, Geraldton, Hedland, Kalgoorlie, Karratha, Kununurra, Northam, Norseman andPinjarra.

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ST JOHN AMBULANCE RESOURCES

Emergency Support Vehicles

Both the metro and country ambulance service are supported by emergency supportvehicles (ESV) that are equipped and ready to be deployed to any mass casualtyincident.

There are three ESV’s based at Belmont:

• ESV1, a 6 tonne, 4WD truck with enough resources to treat up to 140 casualties

• ESV2, a 4WD quick response vehicle that hold enough resources to treat up to 40 casualties and offers an area where the Ambulance Commander can set a command post

• ESV3, a 4WD response vehicle with specialist equipment required by Special Operations Paramedics to undertake vertical rescue, confined space rescue, trench rescue, technical search and rescue, urban search and rescue and respond to hazardous materials or CBRN incidents

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Several country areas also have ESV’s that are 4WD quick responsevehicles capable to treat up to 40 casualties and offer an area where theAmbulance Commander can set a command post.

These are located in:

• Belmont• East Bunbury• Port Hedland• Albany• Broome• Geraldton• Kalgoorlie

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Mass Casualty Kits (MCK)SJA MCK are pre-positioned throughout the state and are able to conservatively treat up to 20 casualties.

They include an: • Administration Tub• Trauma Tub• Cannulation/Fluids Tub• Oxygen Tub• Burns Tub

These kits are situated across Western Australia at numerous career ambulance and volunteer sub-centre locations l

ROYAL FLYING DOCTOR SERVICE

• The Royal Flying Doctor Service (RFDS) provides aero medical and primary healthcare in WA. The RFDS in WA has six facilities located in Jandakot, Kalgoorlie,Meekatharra, Port Hedland, Derby and Broome utilising multiple aircraft.

• The RFDS provide critical life saving intervention through Inter Hospital Transfers,flying patients between hospitals within the state and carrying out PrimaryEvacuations throughout WA as well as the Christmas and Cocos Islands.

• The RFDS usually deal with situations where a patient with serious illness or injuryrequires a medical transfer to a large regional or tertiary centre for definitive care.

• RFDS services operate 24 hours a day, seven days a week and are managed from their state-wide Coordination Centre at their Jandakot facility.

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RAC RESCUE HELICOPTER

• RAC Rescue was established as the State's only emergency rescuehelicopter service in August 2003. In February 2016, a second RACRescue helicopter commenced service. The two helicopters combinednow have the ability to cover 95 per cent of the State’s population.

• The emergency rescue helicopter service is managed by DFES, and isfunded by the WA State Government with Royal Automobile Club (RAC)WA as the principal sponsor. CHC Helicopters provide the helicopter andflight crew.

• Based at Jandakot and Bunbury, the crews include a pilot, air crew officer and SJA critical care paramedic. During critical hospital transfers a doctor may also be on board.

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RAC RESCUE HELICOPTER

• This vital air service transports critical care specialists to an incidentand airlifts the injured to the nearest or most suitable hospital.

• Since inception RAC Rescue has responded to a diverse range ofsignificant emergencies throughout WA including major traffic crashes,undertaking searches, and cliff and sea rescues.

• Working alongside the Perth-based helicopter, the second Bunbury-based helicopter not only benefits community members in the South West, but also increases the capacity of the vital emergency rescue helicopter service to respond to patients across our vast State.

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UNIT 4: WA Health System and Hospital Emergency Management

STATE HEALTH ARRANGEMENTSIn the previous unit we discussed the WA emergency managementarrangements and the role of WAPOL, DFES and SJA. In this unit, we will belooking at the WA Health and hospital emergency management.

WA HEALTH SYSTEMWA Health system’s emergency planning framework aligns with Australian and State requirements, and is based on agraduated, all hazards approach. Accordingly, hospitals should align plans and procedures to this planning framework to ensure a consistent and coordinated approach.

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UNIT 4 – WA Health System and Hospital Emergency Man agement

STATE HEALTH PLANS

State Health Emergency Response Plan (SHERP)

The SHERP is an all hazards response plan that outlines how WA Healthresponds to an emergency or disaster. This plan outlines how WA Health, asa combat agency, will respond to any emergency or disaster within thejurisdiction of WA. The plan provides the Director Generals delegate with theauthority to coordinate all WA Health resources in order to minimise thehealth consequences that arise following a disaster or emergency.

The SHERP may be activated by the delegate at any time for a State or National Health response.

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Infectious Disease Emergency Management Plan (IDEMP)

• The State Human Epidemic Controller (SHEC) is the HMA for thehazard human epidemic.

• A human epidemic is the occurrence of more cases of an infectious ortransmissible disease than would be expected in the State’s populationor a sub-group of the State’s population during a given time period.

• The multi-agency responses are outlined in State Hazard Plan –Human Epidemic and the internal health system arrangements forinfectious disease emergencies are detailed in the Infectious DiseaseEmergency management Plan (IDEMP).

• The IDEMP outlines how WA Health will undertake its combat agencyduties, as directed by the SHEC, to prepare for and respond to anyinfectious disease emergency within WA.

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Hospital Health Service PlansAll hospitals and health services entities are required by policy andaccreditation bodies, to develop a suite of site-specific plans that outline howthe entity manages emergencies. Hospitals and health care facilities utilise anationally recognised set of coloured codes to respond to emergencies as perAS4083:2010 Planning for Emergencies – Health Care FacilitiesThese plans include:

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STATE HEALTH COORDINATORThe State Health Coordinator (SHC) is the HMA for a heatwave or biological hazard.HeatwaveA heatwave is a period of abnormally and uncomfortably hot weather, which could impact on human health, infrastructure and services. Contributing factors include:• Maximum daily temperature and the minimum night time temperature• Duration of the high temperatures• Humidity and air quality• Urban and rural design• Local acclimatisation

Heatwaves have killed more people in Australia than all other natural hazards combined. Climate change is expected to increase the frequency, duration, and intensity of heatwaves and lead to a doubling of heat-related deaths over the next 40 years.

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Actual or impending spillage, release or escape of a biologi calsubstance

Biological hazards, also known as biohazards, refer to biological substancesthat pose a threat to the health of living organisms, primarily that of humans.This can include medical waste or samples of a microorganism, virus or toxin(from a biological source) that can affect human health.

The SHC is the HMA for the prevention of actual or impending spillage,release or escape of a radiological substance, and the prevention,preparedness and response of actual or impending spillage, release orescape of biological substance, both of which are documented in StateHazard Plan - Chemical, Biological, Radiological and Nuclear (CBRN). Arecent example of this was the response to Ebola.

In a heatwave or biological hazard the SHC is responsible for appointing an Incident Controller.

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STATE HUMAN EPIDEMIC CONTROLLERThe State Human Epidemic Controller (SHEC) is the HMA for the hazardhuman epidemic.

The multi-agency responses are outlined in State Hazard Plan – HumanEpidemic and the internal health system arrangements for infectious diseaseemergencies are detailed in the Infectious Disease Emergency managementPlan (IDEMP).

The IDEMP outlines how WA Health will undertake its combat agency duties,as directed by the SHEC, to prepare for and respond to any infectious diseaseemergency within WA.

A human epidemic is the occurrence of more cases of an infectious ortransmissible disease than would be expected in the State’s population or asub-group of the State’s population during a given time period.

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IMPENDING OR ACTUAL EMERGENCIES

In the event of an impending or actual emergency:• Notification is most likely to come from a HMA, a Regional Health Disaster

Coordinator, SJA, a Hospital Health Coordinator or one of a few National level agencies

• The SHC, supported by On-Call Duty Officers (OCDOs) and On-Call Operations Officers (OCOOs) is the first point of contact for notification of emergencies and will determine activation of the SHERP

• On activation of the SHERP the SHC exercises this authority through the State Health Incident Coordination Centre (SHICC)

• On receipt of notification from the SHICC, hospitals will activate their relevant plans

• The Hospital Incident Commander HIC will initiate the activation of the Incident Management Team (IMT)

• Members of the IMT will then attend the Emergency Operations Centre (EOC) to perform their allocated tasks

The OCDO can be contacted at all times via a paging service on (08) 9328 0553.

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WA HEALTH COMMAND SYSTEMIn the first unit we discussed command, control and coordination. In an emergency, what is WA’s Health systems command system?

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As you can see the command is divided into metropolitan and western Australian country health

service (WACHS). Incidents occurring in the regional

areas will be initially controlled by the Local

Health Disaster Coordinator, then District

health Disaster Coordinator and if required the Director

Generals delegate

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HEALTH RESPONSE TEAM (HRT)

• Health Response Teams are teams that can be deployed to anincident site to augment the pre-hospital response.

• The role of a HRT may vary; in the metropolitan area, a HRT may be requested by SJA to assist in providing treatment at a Casualty Clearing Post (CCP).

• In regional and remote areas the HRT may be the only health capability available, and may need to undertake triage, stabilising treatment, and transport. A specialist HRT may also be requested to perform specialist procedures, such as public health screening or amputations.

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HEALTH RESPONSE TEAM (HRT)

• In the metropolitan area, any HRTdeployment, including specialistteams, must be authorised by theSHC. In regional areas, thedeployment of a HRT to an incidentsite must be authorised by theRHDC.

• SJA is generally responsible fortransporting the HRT to and from theincident site.

• Alternative forms of transport may beutilised in difficult access areas.

• In some regional areas, the localhospital may operate the ambulanceservice, and will assume thisresponsibility.

The role of the HRTThe roles of HRTs responding to an emergency include:

Triage• The process of sorting patients according to

their urgency and severity into categories todetermine their immediate health needs.

• The aim of triage is to deliver the right patient tothe right place at the right time, whilst doing themost for the most.

• The MIMMS triage principles of sieve and sortare followed when triaging mass casualties. ASMART triage label is used for the labelling ofthese casualties and one SMART triage pack isallocated per health disaster response kit. Iffurther SMART triage cards are required, SJAwill supply.

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The role of the HRTThe roles of HRTs responding to an emergency include:

Treatment (basic and advanced life support)• The general principle of pre-hospital mass casualty treatment is

to provide enough support and treatment to allow a casualty tobe safely transported to a hospital.

• The amount of treatment provided is generally reflective of thecasualty’s triage score with most treatments in the CCPfocussing on airway, breathing and circulation.

• Treatment may also involve preparation for transport. Patientsready for transport should be moved to the Ambulance LoadingPoint.

Assisting with management of casualties at the incident sit e

Transport

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HRT CompositionThe composition of the team is to be flexible to enable a context specific response. At all times, hospitals and health services are to provide a maximum HRT capability in line with their Clinical Service Framework (CSF) 2014 - 2024 capability.

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KEY MEMBERS OF A HOSPITAL RESPONSE TEAM

Health CommanderThe HRT is commanded by the Health Commander. The Health Commander is responsible for the health resources at the scene, but is not directly involved in clinical care. The Health Commander provides advice to the Incident Controller on the health response to the incident, and serves as an information conduit between the scene and the SHICC (metropolitan incidents) or REOC (regional incidents).

Senior DoctorA Senior Doctor may be appointed by the Health Commander (where staffing permits) to provide clinical governance to the CCP, in collaboration with the Ambulance Casualty Clearing Officer and Senior Nurse. The Senior Doctor serves as the eyes and ears of the Health Commander, relaying information on the operations of the CCP, number of casualties, logistical requirements and staff welfare.

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KEY MEMBERS OF A HOSPITAL RESPONSE TEAM

Senior NurseA Senior Nurse may be appointed by the Health Commander (where staffing permits). Together with the Senior Doctor and Ambulance Casualty Clearing Officer, the Senior Nurse is responsible for the coordination and management of the CCP. The Senior Nurse has overall responsibility for nursing care and allocation of nursing resources.

Communications OfficerThe communications officer assists the Health Commander with relaying information relating to the incident. The communications officer may be deployed to the CCP to relay information from the Senior Doctor to the Health Commander, or assist the Health Commander with relaying information between the SHICC and CCP.

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SPECIALIST TEAMSSpecialist teams may be deployed to provide specialist advice or treatment. Team composition may vary depending upon the nature and magnitude of the incident.

Environmental Health• The Environmental Health Directorate (EHD), Public Health Division, is the principal

regulatory and advisory body on environmental health in WA. The EHD may be requested to provide specialist advice and assistance in an emergency where a hazard(s) poses an imminent threat to the health of humans and the environment.

• An environmental health team may be deployed to provide advice or assistance to the HMA, Local Government or Health Service - Population Health Units in relation to certain hazards.

• Any Environmental Health personnel deployed to an incident site must be authorised by the SHC (metropolitan area) or RHDC (regional areas).

• Any deployed environmental health personnel remain accountable to the authorising delegate.

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SPECIALIST TEAMS

Environmental Health• Hazards where an environmental health team may be deployed to assist the

HMA, Local Government or Health Service - Population Health Units include:

• Water safety (drinking water and recreational waters)• Food safety• Radiation contamination• Human waste• Vermin and vector control• Pesticide misapplications and toxicology (non-clinical)• Hazardous materials (hazmat) contamination or release• Hazardous materials management (e.g. Asbestos);• Chemical toxicology (non-clinical toxicology)

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SPECIALIST TEAMS

Burns Team• Tertiary burn services are responsible for developing and maintaining a pool

of specialist staff that are able to be deployed at short notice to an incident site. The composition of the specialist burn team will be decided at the time of the incident. The team should generally comprise of burn or trauma expertise and members should be capable of performing:

– Burn triage– Initial burn management including:

• Resuscitation• Analgesia• Dressings

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SPECIALIST TEAMS

Specialist Trauma• A specialist trauma team can be deployed to the incident site in the

following circumstances:

– To perform field amputations on trapped victims– To provide surgical management at the scene, due to the number of

patients; overwhelming the capacity to transport victims to hospital

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OTHER CONSIDERATIONS

CBRN / HAZMAT HOSPITAL RESPONSEThe WA health system plays a critical support role in treatment of casualties exposed to a CBRN or HAZMAT incident. Hospitals involved in the response must activate their CBRN/HAZMAT plans. This may involve:

HAZMAT incidents are usually considered accidental.

A CBRN event is associated with a deliberate release of a hazardous material.

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Lockdown of facilities to protect staff, facilities and non-affected patients, relatives and visitors from contamination

Provision of expert advice to the HMA

Deploying a HRT to an incident site for treatment of decontaminated patients in the cold zone

Donning of appropriate Personal Protective Equipment (PPE)

Decontamination of contaminated casualties arriving at hospitals (if not already undertaken prior to arrival at hospital)

Treatment of affected casualties, including symptomatic and definitive treatment

Isolation of casualties who are at risk of causing further contagion or contamination, including communicable biological agents and off-gassing chemical agents

Radiation monitoring of radiologically contaminated casualties

Detection of the agent through symptomology or biological sampling and analysis

Cohort casualties in one hospital to preserve the integrity of other nearby hospitals

Detection and Treatment of the AgentDetection of the agent may be through physical detection systems, symptomology or biological sampling and analysis.

Upon recognition of the agent, hospitals or health services are to immediately notify the SHC. In a large scale incident, the SHICC will notify other health services of the agent, PPE requirements, and treatment regimen.

Treatment regimens are to be based on expert advice from appropriate specialists, and in accordance with CBRN treatment protocols.

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BURN CAPACITYIn a mass burn casualty incident or disaster, a large influx of burn patients mayoverwhelm the normal capacity of specialist burns units. In circumstances where largenumbers of burn patients are expected, burn units and Intensive Care Units (ICUs)should implement departmental surge management strategies to increase bed capacity.In WA there are two dedicated burns units with capacity below:

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Where the facilities’ surge capacity is exhausted, burn patients may be transferred toother tertiary burn facilities throughout Australasia under the auspices ofAUSBURNPLAN.

EMERGENCY WELFARE SUPPORT SERVICES

• Under current WA emergency management arrangements, the Department for Communities has been assigned responsibility for the provision of emergency welfare support services.

• They provides a range of services such as:

– Evacuation Centre management

– Emergency food and clothing

– Counselling services

– Other personal support services

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REGISTRATION AND REUNIFICATION

• WA Health has an obligation under “The Plan - Registration andReunification” to identify, track and record all patients admitted to hospitalsin a disaster or major incident.

• Where there is a need to reunify displaced people and casualties, theAustralian Red Cross may be requested to activate theRegister.Find.Reunite service on behalf of the DCS to assist withregistration and reunification of displaced persons.

• Hospitals should have processes in place to cater for the reception andregistration of relatives and casualties presenting to hospitals.

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MANAGEMENT OF THE DECEASED

• Management of deceased at the incident site is the responsibility of WA Police under the State Disaster Victim Identification (DVI) Plan.

• Victims who die en route to, or at, a health care facility should remain at the health facility until such time as WA Police can arrange transfer to the State Mortuary.

• Depending on the number of fatalities, and the storage capacity of the State Mortuary, there may be a requirement for temporary mortuary facilities to be utilised.

• WA Police will organise temporary mortuary facilities and liaise with the SHICC accordingly.

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REFERENCES

• Office of Emergency Management WA - https://www.oem.wa.gov.au• WA Police - https://www.police.wa.gov.au• Disaster Preparedness and Management Unit 2016, State Health

Emergency Response Plan Interim (SHERP), Western Australia Department of Health, Western Australia

• Disaster Preparedness and Management Unit 2016, Infectious Diseases Emergency Management Plan (IDEMP), Western Australian Department of Health, Western Australia

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FURTHER READING

• Department of Fire and Emergency Services• Office of Emergency Management WA• Saint John Ambulance• Risk Management• State Risk Project• WA Health Department• WA Police• Attorney - General’s Department Emergency Management• Bureau of Meteorology• Australian Health Emergency Preparedness and Response Plans• Red Cross• Emergency WA provides a map based display with up to date emergency

information across the state• All staff members of the Department of Health have access to one of the

libraries of the WA Health Library Network• https://www.flyingdoctor.org.au/wa/#

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